- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.23 / $6,546.00 / $17,538.00
| Facility | | $305.23 | $6,546.00 | $17,538.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.02 / $286.01 / $1,324.33
| Professional | | $230.02 | $286.01 | $1,324.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $5,694.00 / $11,233.00
| Facility | | $2,097.00 | $5,694.00 | $11,233.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.87 / $387.71 / $715.58
| Professional | | $246.87 | $387.71 | $715.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.00 / $100.00 / $5,122.07
| Facility | | $66.00 | $100.00 | $5,122.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.44 / $317.77 / $679.45
| Professional | | $222.44 | $317.77 | $679.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.90 / $329.72 / $555.00
| Facility | | $241.90 | $329.72 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.17 / $348.66 / $711.80
| Professional | | $245.17 | $348.66 | $711.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.94 / $371.81 / $483.35
| Professional | | $291.94 | $371.81 | $483.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.88 / $337.88 / $636.42
| Professional | | $236.88 | $337.88 | $636.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,693.68 / $1,740.00
| Facility | | $55.00 | $1,693.68 | $1,740.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,726.00 / $3,340.19 / $3,340.19
| Professional | | $2,726.00 | $3,340.19 | $3,340.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.72 / $377.99 / $549.07
| Facility | | $296.72 | $377.99 | $549.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.28 / $370.89 / $762.27
| Professional | | $250.28 | $370.89 | $762.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.71 / $821.71 / $1,021.27
| Professional | | $821.71 | $821.71 | $1,021.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.44 / $397.67 / $596.50
| Professional | | $265.44 | $397.67 | $596.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $2,679.00 / $7,399.00
| Facility | | $1,031.00 | $2,679.00 | $7,399.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.82 / $310.22 / $697.57
| Professional | | $240.82 | $310.22 | $697.57 |